光学相干断层扫描辨别肝门部胆管癌肿瘤前沿临床应用研究

Prospection of optical coherence tomography for determining the tumor invasive front of hilar cholangiocarcinoma

目的探索光学相干断层扫描(OCT)技术辨别肝门部胆管癌肿瘤前沿位置的可行性。方法回顾性分析北京清华长庚医院收治的2例术前分别诊断为BismuthⅣ型和Ⅲb型肝门部胆管癌,接受围肝门+左三肝叶切除手术。两枚标本离体后均沿胆管轴向剖开胆总管-肝总管、右前肝管、左肝管。利用OCT设备扫描此三支管道,判断癌与正常胆管交界部位,并进行缝线标记,送病理学检查。结果病理学检查确诊2例均为肝门部胆管癌。OCT扫描可见正常胆管壁表现为低反射的黏膜上皮、高反射的黏膜下结缔-肌层及外层低反射的结缔层。肿瘤区域表现为管壁分层结构消失,多发无反射团块,可伴有乳头状凸起。2枚标本共6处标记,OCT判断肿瘤前沿与病理学检查位置相差<1 mm共4处,相差2 mm共1处,相差7 mm共1处。结论 OCT技术作为快速实时成像方式具有判断肝门部胆管癌肿瘤前沿的应用潜力。

Objective To explore the feasibility of using optical coherence tomography(OCT)technique to determine the tumor invasive front of hepatic hilar cholangiocarcinoma.Methods Two patients were diagnosed in Beijing Tsinghua Changgung Hospital as type BismuthⅣand typeⅢb hilar cholangiocarcinoma respectively and both underwent perihilar and left trihepatectomy.The common bile duct-common hepatic duct,right anterior hepatic duct and left hepatic duct were all opened along the axial direction of the bile duct after the two specimens were excised.OCT equipment was used to scan the three branches to determine the dividing point between cancer and normal bile duct.Suture markers were performed of the 6 positions,and pathological examination was carried out.Results Pathologically,both 2 cases were confirmed as hilar cholangiocarcinoma.Under OCT scan,normal bile ducts showed the inner single layer of epithelial cells was visible as a superficial,hypo-reflective layer.The intermediate connective fibromuscular layer was visible as a hyper-reflective layer and the outer connective layer was visible as a hypo-reflective layer.Malignancies showed unrecognizable layer architecture and multiple presence of nonreflective areas,with or without papillary architecture.Among 6 marker-positions determined by OCT in the 2 specimens,4 sites were less than 1 mm,1 site was about 2 mm and 1 site was about 7 mm apart from pathological tumor invasive front.Conclusion OCT as a fast-real-time imaging technique has the potential to determine the tumor invasive front of hilar cholangiocarcinoma.